Introduction to Immunisations & Cold Chain Management in General Practice. April 2016

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1 Introduction to Immunisations & Cold Chain Management in General Practice April 2016

2 Introduction to Immunisations & Cold Chain Management This session will cover: The role of immunisations in General Practice Cold chain management: Keeping vaccines at a safe temperature Informed patient consent & Pre-vaccination screening Best ways to improve immunisation uptake in your practice

3 The Role of Immunisation in General Practice Why immunise? Immunisation is one of the most effective public health interventions Worldwide programs prevent 2.5 million deaths each year Australia has one of the most comprehensive funded immunisation programs in the world As a result many vaccine-preventable diseases are extremely rare locally

4 The Role of Immunisation in General Practice Why immunise? General Practice is ideally positioned to provide prevention and health promotion care to the community Every encounter is an opportunity to check immunisation status Catch up vaccinations are important for both children and adults

5 National Immunisation Program (NIP)

6 Cold Chain Management Keeping vaccines at a safe temperature What is cold chain? Cold chain is the system of transporting and storing vaccines within the safe temperature range of + 2 C to + 8 C

7 How Sensitive are Vaccines? Vaccines are delicate and less effective or destroyed if they are: Frozen Allowed to get too hot Exposed to direct sunlight or fluorescent light

8 Equipment and People Refrigerator must have enough capacity to store your maximum need Reliable and regularly maintained Know your refrigerator Ensure thermometer is in Celsius: C Check thermometer accuracy & replace battery at least annually Use a temperature monitor chart for each refrigerator Keep door openings to a minimum Do NOT store food or other goods All people handling vaccines need to receive training Have a trained designated person responsible for vaccine storage Have a backup person!

9 Vaccine Storage Tips Do not crowd the vaccines or overfill the shelves Have at least a 4cm gap from all fridge walls Keep vaccines in their original boxes Undertake a self-audit at least every 12 months Keep vaccine stock to a minimum (1 month supply) Avoid placing the refrigerator against an outside wall or in direct sunlight

10 Data Loggers Can be used to audit the fridge Get to know hot and cold spots Print out a report for the week Double check how high or low temperatures were Check how long temperature was out of range for

11 Cold Chain Breach In the event of a breach (below +2 C or above +8 C) Isolate vaccines (do NOT discard) Keep refrigerated between +2 C and +8 C Contact Dept of Health for advice Take steps to correct and prevent the problem from recurring For private vaccines, contact manufacturer for advice Fill out a Cold Chain Breach (CCB) form

12 Managing Cold Chain Problems Power failure If 4hrs or less, keep fridge closed If over 4hrs, store vaccines in a cooler with conditioned ice packs Continue to monitor the temperature by placing a thermometer inside a vaccine box in the cooler

13 How to Condition an Ice Pack Normally needs at least 12hrs in a freezer to be thoroughly frozen To condition: Remove ice packs from freezer Lay out on a single row on their side Leave 5cm space around each pack Wait until packs begin to sweat (up to 1hrs at +20 C and less in hotter days) Ice pack is conditioned as soon as water begins to slosh about slightly inside the pack

14 Temperature Record Chart

15 Pre-Vaccination Screening Preparing an anaphylaxis response kit Anaphylaxis protocols, equipment and drugs necessary for management should be checked before each vaccination session

16 Pre-Vaccination Screening An anaphylaxis response kit should be on hand at all times and should contain: Adrenaline 1:1000 (minimum of three ampoules check expiry dates) Minimum of three 1 ml syringes and 25 mm length needles (for intramuscular [IM] injection) Cotton wool swabs Pen and paper to record time of administration of adrenaline Laminated copy of adrenaline doses (back cover of Immunisation Handbook) Laminated copy of Recognition and treatment of anaphylaxis (back cover of the Handbook).

17 Pre-Vaccination Screening Check which vaccine(s) are indicated, including any previously missed vaccine doses Consider whether additional vaccines should be given Check if there are any contraindications or precautions to the vaccines that are to be given Ensure the patient is the appropriate age for the vaccines to be given Check that the correct time interval has passed since any previous vaccine(s) or any blood products were given.

18 Valid Consent Voluntary After sufficient, appropriate and reliable information about the procedure Including the potential risks and benefits Including adverse events are possible, how common they are and what they should do about them Consent should be obtained before each vaccination session Can be verbal or written

19 Communicating Risks and Benefits of Vaccines Use plain language Encourage patients to ask for further information and provide sufficient time to make a decision Ideally, printed information should be available to supplement verbal explanations Detailed vaccine information can be found: The Immunise Australia website ( The National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases website (

20 Best Ways to Improve Immunisation Uptake in Your Practice Good immunisation awareness: waiting room posters, fact sheets and well informed staff Check immunisation status at every encounter Robust Recall and Reminder system Consistent patient notification system eg HotDoc s SMART Recalls Jargon-free patient information Check provider and practice due/overdue reports Report immunisations administered to the relevant register

21 Nurses scope of practice RN Div 1 or Med-endrosed EN Div 2 All vaccines are Schedule 4 drugs Vaccines must be initiated/authorised by a GP prior to administration A GP must be readily available (at the clinic) in case of anaphylaxis (including until the last patient s 15min waiting time is up) The authorising/ordering GP must make an entry in the patient file Credentialed Nurse Immunisers May initiate vaccines as per the National Immunisation Schedule GP intervention is not required Nurse must have CPR and anaphylaxis management skills up to date

22 Billing considerations Bulk billing vs Private billing MBS Items: 3 Brief. Must include a GP consult & entry in patient file 23 - Standard (up to 20min). Must include a GP consult & file entry Nurse Monitor/Support. Patient must have a GPMP in place. Consult must include a documented element of monitoring or support of the patient s chronic illness and not simply giving the jab Private billing without a Medicare rebate Private fee for nurse consult ($5 - $15+) Private fee for vaccine if not eligible for Government supply Must use private stock if charging for vaccines

23 Resources & Guidelines

24 Thank you for participating! Got a question? md@hotdoc.com.au